输尿管软镜在治疗经皮肾镜取石术后残余肾结石中的应用价值

Application values of flexible ureteroscope in treatment of retained kidney calculi after percutaneous nephrolithotomy

目的 探讨输尿管软镜在治疗经皮肾镜取石术后残余肾结石中的临床疗效.方法 回顾性分析36例采用输尿管软镜治疗经皮肾镜取石术后残余肾结石的临床资料.结果 36例患者中,26例采用经皮肾镜通道,10例采用经输尿管通道,除1例于术后7d采用经皮肾镜通道碎石术中出现活动性出血致视野不清而终止手术外,其余未发生严重手术并发症.均于本次术后第2、7和14天复查腹部平片,结石清除率分别为13.9％（5/36）、69.4％（25/36）和94.4％（34/36）.2例患者肾下盏仍有小于0.4 cm结石残留,正持续随访中.结论 输尿管软镜可有效处理经皮肾镜取石术后残余肾结石,避免二期经皮肾镜取石术或多通道经皮肾镜取石术,提高经皮肾镜治疗复杂性肾结石的清除率,且损伤小、经济、安全、简便,可作为经皮肾镜取石术有效的补充方案.

Objective To explore the effect of flexible ureteroscope in treatment of retained kidney calculi after percutaneous nephrolithotomy.Methods Thirty-six patients with retained kidney calculi after percutaneous nephrolithotomy who were treated with flexible ureteroscope were selected,and clinical data of the patients were retrospectively analyzed.Results In the 36 patients,26 patients were through the percutaneous nephroscope channel,and 10 patients were through the ureter channel.Except for 1 patient who stopped the operation because of poor visibility caused by active bleeding in percutaneous nephroscope channel lithotripsy 7 d after percutaneous nephrolithotomy,other patients did not appear severe complication.All the patients were rechecked plain abdominal radiograph the second,seventh and fourteenth day after this operation,and the eradication rates of calculi were 13.9% （5/36）,69.4% （25/36） and 94.4% （34/36）.Two patients still had less than 0.4 cm retained calculi in lower renal calices and were followed up.Conclusions The retained kidney calculi after percutaneous nephrolithotomy can be effectually treated by flexible ureteroscope,and it can avoid secondary percutaneous nephrolithotomy or multichannel percutaneous nephrolithotomy,and inprove the eradication rate of complex kidney calculi by percutaneous nephrolithotomy.The method is economical,safe,simple and with little injury,and it is the effective supplement protocol of percutaneous nephrolithotomy.